Endoleaks

Late outcomes. We recommend treatment of type I endoleaks. Level of recommendation 1 (Strong), Quality of evidence B (Moderate)

We suggest treatment of type II endoleaks associated with aneurysm expansion. Level of recommendation 2 (Weak), Quality of evidence C (Low)

We recommend surveillance of type II endoleaks not associated with aneurysm expansion. Level of recommendation 1 (Strong), Quality of evidence B (Moderate)

We recommend treatment of type III endoleaks. Level of recommendation 1 (Strong), Quality of evidence B (Moderate)

We suggest no treatment of type IV endoleaks. Level of recommendation 2 (Weak), Quality of evidence C (Low)

We recommend open repair if endovascular intervention fails to treat a type I or type III endoleak with ongoing aneurysm enlargement. Level of recommendation 1 (Strong), Quality of evidence B (Moderate)

We suggest open repair if endovascular intervention fails to treat a type II endoleak with ongoing aneurysm enlargement. Level of recommendation 2 (Weak), Quality of evidence C (Low)

We suggest treatment for ongoing aneurysm expansion, even in the absence of a visible endoleak. Level of recommendation 2 (Weak), Quality of evidence C (Low)

Limb occlusion

We recommend that follow-up of patients after aneurysm repair include a thorough lower extremity pulse examination or ankle-brachial index (ABI). Level of recommendation 1 (Strong), Quality of evidence B (Moderate)

We recommend a prompt evaluation for possible graft limb occlusion if patients develop new-onset lower extremity claudication, ischemia, or reduction in ABI after aneurysm repair. Level of recommendation 1 (Strong), Quality of evidence A (High)

Aortic graft infection

We recommend antibiotic prophylaxis to prevent graft infection before any dental procedure involving the manipulation of the gingival or periapical region of teeth or perforation of the oral mucosa, including scaling and root canal procedures, for any patient with an aortic prosthesis, whether placed by OSR or EVAR. Level of recommendation 1 (Strong), Quality of evidence B (Moderate)

We suggest antibiotic prophylaxis before respiratory tract procedures, gastrointestinal or genitourinary procedures, and dermatologic or musculoskeletal procedures for any patient with an aortic prosthesis if the potential for infection exists or the patient is immunocompromised. Level of recommendation 2 (Weak), Quality of evidence C (Low)

After aneurysm repair, we recommend prompt evaluation for possible graft infection if a patient presents with generalized sepsis, groin drainage, pseudoaneurysm formation, or ill-defined pain. Level of recommendation 1 (Strong), Quality of evidence A (High)

We recommend prompt evaluation for possible aortoenteric fistula in a patient presenting with gastrointestinal bleeding after aneurysm repair. Level of recommendation 1 (Strong), Quality of evidence A (High)

In patients presenting with an infected graft in the presence of extensive contamination with gross purulence, we recommend extra-anatomic reconstruction followed by excision of all graft material along with aortic stump closure covered by an omental flap. Level of recommendation 1 (Strong), Quality of evidence B (Moderate)

In patients presenting with an infected graft with minimal contamination, we suggest in situ reconstruction with cryopreserved allograft. Level of recommendation 2 (Weak), Quality of evidence B (Moderate)

In a stable patient presenting with an infected graft, we suggest in situ reconstruction with femoral vein after graft excision and débridement. Level of recommendation 2 (Weak), Quality of evidence B (Moderate)

In unstable patients with infected graft, we recommend in situ reconstruction with a silver- or antibioticimpregnated graft, cryopreserved allograft, or polytetrafluoroethylene (PTFE) graft. Level of recommendation 1 (Strong), Quality of evidence B (Moderate)